Neonatologist Royal Prince Alfred Hospital Camperdown, New South Wales, Australia
Background: Respiratory distress (RD) occurs in up to 7% of newborns. Using non-invasive respiratory support (RS) strategies may reduce the need for mechanical ventilation and the risk of lung damage in newborn infants with RD. Objective: To assess the effects of non-invasive high-frequency ventilation (nHFV) with invasive ventilation or non-invasive ventilation for RD in newborn infants. Design/Methods: Cochrane systematic review of randomized controlled trials of nHFV in newborn infants with respiratory distress compared to invasive ventilation or non-invasive ventilation. Searches performed in April 2023. Two authors independently selected the trials for inclusion, extracted data, assessed the risk of bias, and GRADE assessment. Results: nHFV vs nasal continuous positive airway pressure (nCPAP) used for initial RS: There was no difference in mortality (RR 1.00, 95% CI 0.41 to 2.41; 4 studies, 531 infants; very low‐certainty). nHFV probably reduces ET intubation (RR 0.52, 95% CI 0.33 to 0.82; 5 studies, 571 infants; moderate‐certainty). There was no difference in CLD (RR 1.35, 95% CI 0.80 to 2.27; 4 studies, 481 infants). nHFV vs nasal intermittent positive-pressure ventilation (nIPPV) used for initial RS: There was no difference in mortality (RR 1.86, 95% CI 0.90 to 3.83; 2 studies, 84 infants; low‐certainty) or ET intubation (RR 1.33, 95% CI 0.76 to 2.34; 5 studies, 228 infants; low‐certainty). There may be a reduction in CLD with nHFV (RR 0.63, 95% CI 0.42 to 0.95; 5 studies, 307 infants; low-certainty). nHFV vs nCPAP used for RS following planned extubation: There was no difference in mortality (RR 0.92, 95% CI 0.52 to 1.64; 6 studies, 1472 infants; moderate-certainty). nHFV results in a reduction in ET reintubation (RR 0.42, 95% CI 0.35 to 0.51; 11 studies, 1897 infants; high‐certainty) and CLD (RR 0.78, 95% CI 0.67 to 0.91; 10 studies, 1829 infants (moderate-certainty). nHFV versus nIPPV used for RS following planned extubation: There was no difference in mortality (RR 1.83, 95% CI 0.70 to 4.79; 2 studies, 984 infants; low‐certainty). There is a reduction in ET reintubation (RR 0.69, 95% CI 0.54 to 0.89; 6 studies, 1364 infants; high‐certainty) but no effect on CLD (RR 0.88, 95% CI 0.75 to 1.04; 4 studies, 1236 infants).
Conclusion(s): For initial RS, nHFV probably reduces ET intubation when compared to nCPAP or nIPPV. For planned extubation, nHFV reduces the risk of ET reintubation compared to nCPAP and nIPPV. nHFV probably reduces the risk of CLD when compared to nCPAP. Using nHFV is justified for initial RS and planned extubation to reduce the rate of (re-)intubation and risk of CLD.
